National initiative boosts heart failure treatment across US hospitals

About 6.7 million adults in the U.S. are living with heart failure, and that number is expected to increase to more than 8 million by 2030.

A new analysis published in Circulation: Heart Failure shows hospitals participating in the American Heart Association's multiregional IMPLEMENT-HF™ initiative significantly improved adherence to guideline-directed medical therapy for patients hospitalized with heart failure with reduced ejection fraction (HFrEF), the most common type of heart failure.

The American Heart Association, a global force changing the future of health for all, launched the three-year quality improvement initiative in 2021. The goal: improve uptake of quadruple medical therapy and integrate health-related social needs assessments into routine care. Quadruple medical therapy is a combination of four evidence-based drugs proven to reduce mortality: angiotensin receptor–neprilysin inhibitor (ARNI), evidence-based specific β-blocker (BB), mineralocorticoid antagonist (MRA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i). The effort involved more than 100 hospitals across the U.S. and built on the Association's Get With The Guidelines® – Heart Failure program.

The study included data from more than 43,000 patients at 67 hospitals and found:

• Use of all four drug classes recommended for HFrEF rose from 4.7% to 44.6% at hospital discharge among initiative participants, and from 0% to 44.8% within 30 days post-discharge;
• The improvement in care was consistent across race, ethnicity and gender; and
• Hospitals also dramatically increased the use of tools to assess patients' social needs – an important step toward more equitable care.

"This initiative represents an important leap forward in closing the treatment gap in heart failure," said Andrew Sauer, M.D., American Heart Association volunteer, a lead author of the research and a cardiologist at Saint Luke's Mid America Heart Institute in Kansas City. "By supporting collaborative learning and leveraging real-time data, IMPLEMENT-HF enabled hospitals to better serve patients in varied communities."

HFrEF affects nearly half of people hospitalized for heart failure and carries a 75% five-year mortality rate. Although clinical trials have shown that quadruple therapy can significantly improve survival, use of this treatment has remained low nationwide, particularly among underrepresented populations.

By creating a structured, "all-teach, all-learn" environment, the Association's initiative offered participants tools for identifying care gaps, sharing best practices and monitoring performance at both hospital and regional levels.

The improvements we've seen through IMPLEMENT-HF underscore the power of collaboration. The Association is committed to transforming systems of care to ensure every person has access to the highest standard of heart failure treatment, no matter where they live."

Mariell Jessup, M.D., chief science and medical officer, American Heart Association